Discordant Orthostatic Reflex Renin–Angiotensin and Sympathoneural Responses in Premenopausal Exercising-Hypoestrogenic Women
Discordant Orthostatic Reflex Renin–Angiotensin and Sympathoneural Responses in Premenopausal Exercising-Hypoestrogenic Women
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绝经前运动低雌激素女性体位性反射肾素-血管紧张素和交感神经反应不一致
作者：
E. O’Donnell;J. Goodman;S. Mak;H. Murai;Beverley L. Morris;J. Floras;P. Harvey
我们之前对血压正常的绝经后女性的观察激发了这样的假设：与正常月经的女性相比，患有功能性下丘脑闭经的活跃的低雌激素绝经前女性将表现出肾素-血管紧张素-醛固酮系统对直立性挑战的反射性反应减弱，而为了防御血压，肌肉中的反射性增加，交感神经活动将增强。为了检验这些假设，我们评估了 12 名患有闭经的女性（ExFHA；年龄 25±1 岁；体重指数 20.7±0.7 kg/m2；平均值±SEM）和 17 名正常月经的女性（ExOv；24±1 岁；20.9±0.5 kg/m2）的血压、心率、血浆肾素、血管紧张素 II、醛固酮和仰卧休息时和分级下半身负压（-10、-20 和 -40 mm Hg）期间的肌肉交感神经活动。基线时，ExFHA（47±2次/分钟和94±2 mmHg）的心率和收缩压低于ExOv（56±2次/分钟和105±2 mmHg）（P<0.05），但肌肉交感神经活动和肾素-血管紧张素-醛固酮系统成分相似（P>0.05）。对于分级较低的身体负压，两组的心率均增加（P<0.05），收缩压均下降（P<0.05），但 ExFHA 中的这些指标始终较低（P<0.05）。下半身负压引起 ExOv 中肾素、血管紧张素 II 和醛固酮的增加（P<0.05），但 ExFHA 中却没有增加（P>0.05）。两组的肌肉交感神经活动爆发发生率反射性增加，但 ExFHA 组更明显（P<0.05）。否则，健康的低雌激素 ExFHA 女性表现出低血压，并且对直立性挑战的正常循环反应受到破坏：血浆肾素、血管紧张素 II 和醛固酮无法增加，并且通过增强的交感血管收缩反应来保护血压。
Our prior observations in normotensive postmenopausal women stimulated the hypotheses that compared with eumenorrheic women, active hypoestrogenic premenopausal women with functional hypothalamic amenorrhea would demonstrate attenuated reflex renin–angiotensin–aldosterone system responses to an orthostatic challenge, whereas to defend blood pressure reflex increases in muscle, sympathetic nerve activity would be augmented. To test these hypotheses, we assessed, in recreationally active women, 12 with amenorrhea (ExFHA; aged 25±1 years; body mass index 20.7±0.7 kg/m2; mean±SEM) and 17 with eumenorrhea (ExOv; 24±1 years; 20.9±0.5 kg/m2), blood pressure, heart rate, plasma renin, angiotensin II, aldosterone, and muscle sympathetic nerve activity at supine rest and during graded lower body negative pressure (−10, −20, and −40 mm Hg). At baseline, heart rate and systolic blood pressure were lower (P<0.05) in ExFHA (47±2 beats/min and 94±2 mm Hg) compared with ExOv (56±2 beats/min and 105±2 mm Hg), but muscle sympathetic nerve activity and renin–angiotensin–aldosterone system constituents were similar (P>0.05). In response to graded lower body negative pressure, heart rate increased (P<0.05) and systolic blood pressure decreased (P<0.05) in both groups, but these remained consistently lower in ExFHA (P<0.05). Lower body negative pressure elicited increases (P<0.05) in renin, angiotensin II, and aldosterone in ExOv, but not in ExFHA (P>0.05). Muscle sympathetic nerve activity burst incidence increased reflexively in both groups, but more so in ExFHA (P<0.05). Otherwise, healthy hypoestrogenic ExFHA women demonstrate low blood pressure and disruption of the normal circulatory response to an orthostatic challenge: plasma renin, angiotensin II, and aldosterone fail to increase and blood pressure is defended by an augmented sympathetic vasoconstrictor response.
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